“The moral test of a government is how it treats those who are at the dawn of life, the children; those who are in the twilight of life, the aged; and those who are in the shadow of life, the sick and the needy, and the handicapped.” – Hubert Humphrey
passionate pachyderms
Pharmacist Steve steve@steveariens.com 502.938.2414
HAYS, Kan. — Police cited a terminally ill Kansas man at the hospital because he allegedly used a weed vape and THC paste to ease the symptoms of the cancer that will kill him within weeks.
On Dec. 16, Hays, Kansas police raided the hospital room of 69-year-old Greg Bretz, who is suffering from terminal cancer, after a hospital worker at Hays Medical Center caught him vaping marijuana, KSNF reports.
Bretz said he has been vaping, as well as eating THC paste with bread, to relieve symptoms of his condition since being hospitalized roughly three weeks ago.
Bretz is in the final stages of terminal, inoperable cancer and told The Wichita Eagle that he most often lies “flat on his back” in his hospital bed and can’t stand up without being assisted. Bretz told the Kansas City Star that his doctor told him to use whatever was necessary to relieve his pain, including products containing THC — the active ingredient in cannabis.
Police told Bretz that his vaping device could potentially be a fire hazard, due to the presence of oxygen in the room. In many vaping devices, puffing activates the battery-powered heating device, which vaporizes the liquid in the cartridge or reservoir for inhalation.
Medicinal cannabis is illegal Kansas, despite 68% of state residents support state-sanctioned medical marijuana access, according to the National Organization for the Reform of Marijuana Laws (NORML). Idaho and Nebraska also ban the practice.
Walmart said it has reached settlement agreements with all 50 US states as part of a $3.1 billion nationwide opioid settlement announced last month.
In November, the retailer announced a settlement from multiple states’ attorneys general that accused the company of failing to regulate opioid prescriptions contributing to the nationwide opioid crisis.
The settlement, according to the office of New York Attorney General Letitia James, who co-led a coalition of attorneys general in the negotiation, will also “include broad, court-ordered requirements Walmart must comply with, such as robust oversight to prevent fraudulent prescriptions and flag suspicious prescriptions.”
In this week’s announcement, Walmart said that the agreements with the 50 states “are intended to resolve substantially all opioids-related lawsuits brought by state and local governments against Walmart.”
“Walmart believes these settlements are in the best interest of all parties and will provide significant aid to communities across the country in the fight against the opioid crisis, with aid reaching state and local governments faster than any other nationwide opioid settlement to date, subject to satisfying all settlement requirements,” the company said in the statement.
Walmart added that it “strongly disputes the allegations in these matters, and these settlements do not include any admission of liability.”
“Promising negotiations,” are still underway with other pharmacies including Walgreen (WBA)s and CVS (CVS), James’ office said last month. Those two chains have tentatively agreed to pay a combined $10 billion to settle lawsuits brought by states and local governments alleging the retailers mishandled prescriptions of opioid painkillers.
US states, cities and counties have filed more than 3,000 lawsuits against opioid manufacturers, distributors and pharmacies, accusing them of downplaying the addiction risk and failing to stop pills from being diverted for illegal use.
More than 500,000 overdose deaths over the past two decades – including more than 80,000 in 2021 alone – are blamed on the US opioid crisis, government data show, with an estimated 9.5 million Americans age 12 and older reported in 2020 to have misused opioids, including 9.3 million prescription pain reliever abusers and 902,000 heroin users.
The California Board of Pharmacy has filed a complaint accusing CVS Caremark of neglecting red flags that should have given the PBM and mail-order pharmacy “reason to know or suspect that numerous controlled substances … were not issued for a legitimate medical purpose” from July 2018 through July 2021. The drugs included the anxiety drug alprazolam (Xanax—Pfizer), the ADHD drug amphetamine/dextroamphetamine (Adderall—Shire), and opioid analgesics such as hydromorphone (Dilaudid—Rhodes Pharmaceuticals) and acetaminophen/oxycodone (Percocet—Endo Pharmaceuticals).
The board wants the license for the CVS unit to be revoked or at least suspended. The board also wants to prohibit certain CVS Health leaders from serving as an officer or manager in connection with that particular CVS license for 5 years, if the unit is placed on probation or until the license is reinstated.
In addition, records show the mail-order unit shipped more than 2,100 prescriptions prematurely to patients, according to the board. CVS also allegedly violated a law that requires controlled substances to be prescribed to state residents only by prescribers licensed in California. The board found that just three of the top 100 providers whose prescriptions were handled by the CVS unit held licenses to practice medicine in California, at least during part of the time that the investigation took place. The remainder were not allowed to practice medicine without restrictions in California, according to the complaint.
Hospital closures, service reductions, mergers and acquisitions are creating a bed shortage and impeding patients’ access to timely care, a group of Massachusetts lawmakers contend in a letter to HHS that requests information from the agency on its part in monitoring or interfering with service reductions.
Citing more than a dozen studies, analyses and news articles, the 10 lawmakers argue that demand for hospitals and healthcare organizations exceeded capacity even before the COVID-19 pandemic, resulting in lower quality of care, longer waiting times and higher prices. Hospital closures, service reductions, mergers and acquisitions are now adding to the “worrying signs of distress,” the lawmakers wrote to HHS.
“Despite health care systems operating over capacity and receiving substantial financial support from federal, state and local government in recent years, hospitals across the country are closing their doors, reducing their services, or consolidating,” the letter states. “We are concerned that this pattern will result in communities facing increasingly significant barriers to healthcare, and seek your assistance in ensuring those communities have sufficient hospital resources to guarantee access to a full continuum of high-quality care.”
They requested answers from the agency to seven questions by Jan. 15 to “better understand whether, and if so how, federal government action or inaction has impacted hospital closures and service reductions”:
1. What data does HHS gather on hospital closures, service reductions, or mergers or acquisitions due to financial distress? 2. What data does HHS gather on spillover effects on surrounding healthcare facilities after hospital closures? 3. What actions is HHS taking to identify the effects of hospital closures or service reductions on public health and health care access? 4. What actions is HHS taking to ensure accessibility for communities that rely on safety-net hospitals? 5. What engagement has HHS had with stakeholders at the local, state and federal levels to address concerns with hospital closures and service reductions? 6. What support does HHS provide to hospitals to adopt models of care to mitigate or avoid financial distress? 7. What support does HHS provide to health care systems to ensure long-term financial sustainability and surge capacity?
Massachusetts’ Sen. Edward J. Markey initiated the communication to HHS. Sen. Elizabeth Warren and Reps. James P. McGovern, Lori Trahan, Jake Auchincloss, Katherine Clark, Seth Moulton, Ayanna Pressley, Stephen F. Lynch and Bill Keating signed the letter.
As respiratory viruses surge across the country, a number of public-health officials and doctors are encouraging masking to protect against flu and RSV, in addition to Covid-19.
Whether masks are enough—and whether people are willing to wear them after the country has largely moved on from pandemic precautions—is another matter.
“I’m not optimistic” that people are willing to mask again, says Eric Topol, director of the Scripps Research Translational Institute in La Jolla, Calif. “There’s such a reluctance to go what is considered backward, even though it’s actually forwards in terms of helping one another.”
Masks help provide protection against flu and RSV, medical experts say, as do other precautions. RSV, a common respiratory virus, also often spreads through expelled virus particles on surfaces, so frequent hand-washing and cleaning of contaminated surfaces can help fight its spread, says Scott Roberts, an infectious disease specialist at the Yale School of Medicine.
Most Americans never considered wearing a face mask to prevent the spread of illnesses until Covid emerged. Since 2020, the face protections and guidance around them often grew contentious, with disputes erupting over schools, at workplaces and within families. On Monday, Rochelle Walensky, the director of the Centers for Disease Control and Prevention, encouraged Americans to wear high-quality, well-fitting masks to help prevent the spread of many respiratory viruses.
The CDC is considering incorporating other respiratory illnesses into its calculations that assess when and where people should wear masks, Dr. Walensky said Monday, adding: “One need not wait on CDC action in order to put a mask on.”
About a third of Americans say they aren’t likely to wear a mask outside of their homes if Covid-19 cases increase in their area, according to a poll conducted in early December by Axios and Ipsos.
Public health officials in Los Angeles County, where Covid-19 cases have been rising since late October, appear to be poised to reinstate a mask mandate for indoor public settings when the county’s CDC community level moves from medium to high and two thresholds for hospitalization are met. Los Angeles County public health director Barbara Ferrer said on Dec. 1 that masking could be reinstated by later this month. In response to news stories about the potential reinstatement, many social-media users expressed a reluctance to comply.
For the week that ended Nov. 26, the CDC classified most of the U.S. as having high or very high levels of influenza-like illness, which can include cases of Covid-19 and RSV, also known as respiratory syncytial virus.
Well-fitting masks are especially good at reducing transmission by respiratory droplets emitted when people cough, sneeze or talk, which is one way that flu, RSV and Covid spread. Public transportation, including flights, and indoor gatherings with people whose exposure status you don’t know—especially in spaces that are crowded or poorly ventilated—are good places to be vigilant, public health experts say.
RSV is often spread by touching an infected surface, which is less common with flu and Covid. Frequent hand-washing is important to guard against RSV, although it’s a sensible precaution against other illnesses too, doctors say.
Getting vaccinated against Covid-19 and flu will provide a layer of protection against those viruses. This year’s flu vaccine formulation appears to be a “very good match” to circulating strains, according to the CDC.
There is no RSV vaccine. Carrying hand sanitizer or sanitizing wipes with you to the office and social gatherings is a good idea, says Dr. Roberts.
As holiday gatherings approach, those planning to spend time with elderly or immunocompromised people should consider wearing a mask regularly for a week before getting together, says Katelyn Jetelina, an epidemiologist who writes the public health newsletter “Your Local Epidemiologist.” RSV and flu can also be dangerous in very young children.
Getting tested is an important precaution, too. Dr. Topol said he plans to take a rapid Covid-19 test before a meeting next week, and has asked other participants to do the same.
Is Congress trying to tell everyone that they had better start increasing their retirement contributions? The last of the Baby Boomers will be entitled to full SS benefits in 2031, when they turn 67 y/o. It is estimated that SS will “run out of money” is in 2035..https://money.com/social-security-run-out-date/. SS will not necessarily “go broke” SS currently works on a cash flow basic and current in-flow to social security is greater than the out-flow to SS beneficiaries. It is currently estimated that when SS goes into a negative cash flow that everyone’s monthly SS money will drop abt 20%. Right now the typical couple draws 40K-45K a year. So in 2035 the typical couple will get $800- $1000 less per month less.
Congress includes major retirement overhaul in year-end $1.7T spending bill
Secure 2.0 could help Americans save more for retirement
A collection of provisions designed to overhaul the U.S. retirement system and help Americans save more could soon become law.
Included in the sweeping, end-of-year spending package that Congress is expected to vote on in the coming days are a series of measures that are part of the long-delayed “Secure 2.0 Act.” Lawmakers have until Friday to pass the $1.7 trillion omnibus spending package in order to keep the government funded, or to approve a continuing resolution to push the deadline into next year.
Secure 2.0 – a follow-up to the 2019 Secure Act – is designed to bolster Americans’ retirement savings by making a number of key changes to existing retirement account rules and certain related tax breaks.
“Including Secure 2.0 retirement provisions in the last major legislation of the year means that Congress is poised to help millions more workers and retirees with significant improvements to the nation’s private retirement system,” Paul Richman, the chief government and political affairs officer at the Insured Retirement Institute, said in a statement.
People walk outside the U.S Capitol building in Washington, June 9, 2022. (AP Photo/Patrick Semansky, File / AP Newsroom)
Here are some of the ways that Secure 2.0 would overhaul the current retirement system:
Automatic 401(k) enrollment
Beginning in 2025, employers that offer 401(k) or 403(b) savings plans would be required to automatically enroll employees at a rate of at least 3%, with mandatory 1% increases each year to a maximum rate of 10%. Employees could choose to opt out of the plan.
Small businesses with 10 or fewer workers and new businesses in existence for fewer than three years would be exempt from the rule.
President Biden speaks to African leaders gathered for the U.S.-Africa Leaders Summit Wednesday, Dec. 14, 2022, in Washington. ((AP Photo/Patrick Semansky) / AP Newsroom)
Creating bigger “catch up” contributions for older savers
Under current law, Americans who are 50 or older can make so-called catch-up contributions of no more than $6,500 per year to their 401(k) and 403(b) plans, with a limit of $27,000.
But Secure 2.0 would increase the annual catch-up by 50% to $10,000, indexed annually for inflation, for participants between the ages of 60 and 63 starting in 2025.
On top of that, all catch-up contributions would be subject to Roth rules – meaning individuals pay taxes on the money upfront.
Increased age for RMDs
The bill would raise the age that Americans must take a required minimum distribution from their retirement plan to 73 beginning in 2023, up from the current age of 72.
In 10 years, the RMD age would once again move up to 75.
Emergency expense distributions
Beginning in 2024, Americans would be allowed to take an early “emergency” distribution from their retirement accounts to cover unexpected or immediate financial needs. Individuals could take out as much as $1,000. The money could be taken once a year and would not be subject to the usual 10% tax that applies to early distributions.
However, there is a catch: Anyone who takes the emergency expense option but does not pay it back within a certain time frame will not be allowed to tap the retirement fund penalty free for another three years.
Expanding employer 401(k) match options
Another aspect of Secure 2.0 would make it easier for employers to make contributions to 401(k) plans on behalf of employees paying off student loan debt. Employers could essentially make a matching contribution to your retirement account based on your student loan payment amount – a rule intended to remove student loan debt as a major obstacle to retirement savings.
Incentives for retirement plan contributions
Secure 2.0 would allow employers to offer small financial incentives to employees to encourage them to participate in any offered retirement plans.
The DEA claims that they don’t practice medicine, but… they established what they believe is a standard of care and best practices for practitioners to follow and if anyone exceeds those dosing mgs/limits must be prescribing controlled substances ILLEGALLY. Of course, the SCOTUS in June 2022, with a 9-0 vote on the Ruan/Kahn hearing that the DEA could not use objective criteria when judging a practitioner in treating pts dealing with subjective diseases. The SCOTUS in June, 2022 also told ATF & EPA that they had no statutory authority – that belonged to Congress -to create new regulations or interpretations of the laws they were charged in enforcing, but… much of what the DEA uses to charge practitioner is DEA created interpretations or new DEA regulation off of the CSA. But apparently, that SCOTUS ruling did not cause all of these new interpretations and regulations that various fed agencies have created over the existence of the law that the agency is in place to enforce those laws.
Op-Ed: Finally, some promising news on opioids for patients in severe pain
The U.S. remains in the midst of an ever-worsening drug overdose crisis. Because prescription opioids drove its earlier phases, the nation responded by drastically reducing access to those drugs — with prescriptions dropping by nearly 50% over the last decade. But it’s now clear that approach was ineffective at combating overdoses, and it left many patients with painful medical conditions stranded.
Overdose deaths have continued to soar even as fewer opioids have been prescribed. More dangerous drugs filled the gap: At least two-thirds of overdose deaths are now tied to synthetic opioids, mostly fentanyl, a powerful black market opioid. Meanwhile, physicians have had to balance the risk of criminal prosecution for prescribing opioids against their responsibility to treat patients’ pain.
Yet there is promising news amid our nation’s cycle of failed attempts to tackle the crisis. Two key shifts in federal policy this year hint that the pendulum is beginning to swing back toward more access to opioids for patients who need them.
The first is opioid prescribing guidelines that the Centers for Disease Control and Prevention updated last month. They undo a controversial feature of the agency’s 2016 guidance: the cap on opioids at 90 morphine milligram equivalents, or MME, per day. Although this number was never meant to serve as a hard line, law enforcement, regulators and healthcare providers widely interpreted it as one. The problem is that some patients need more than that amount. The validity of using any MME metric has also come under fire. Recent studies show that there is no universal standard for calculating appropriate MME, and methods to determine cutoffs vary widely; a patient who is considered “high risk” for overdose or addiction when evaluated using one method could be “undertreated” according to another.
But these arbitrary standards changed the landscape. Following the 2016 guidelines, insurance companies began to deny payment for pain management above 90 MME. Physicians faced a climate of mounting fear: Although U.S. law allows physicians to prescribe opioid medications for “legitimate medical purposes,” that definition grew more contentious. Law enforcement agencies, including the Drug Enforcement Administration, cited the 90 MME limit in investigations. While some doctors were financially incentivized to overprescribe opioids, others caught scrutiny simply for providing relief to patients in debilitating pain.
After taking higher doses for years, many patients were rapidly tapered under the limit, no matter how painful their health condition was. Some were cut off entirely, unable to find a doctor still willing to prescribe for their chronic pain.
Since then, extensive research has shown that some healthcare providers were inappropriately reducing opioid prescriptions even for cancer, palliative and end-of-life patients, who were supposed to be exempt from limits. Tragically, recent studies found that chronic pain patients who are rapidly tapered off opioids have high rates of suicide and overdose, as people turn to desperate measures for pain relief, including seeking illicit street opioids.
In a step forward for treatment, this year’s CDC guidelines avoid emphasizing specific thresholds. Recognizing the harms of excessive tapering and limits, they instead discuss ranges of dosages appropriate for different conditions and highlight the need for doctors to use their clinical judgment for each patient.
The second major shift on opioids this year was the June Supreme Court ruling in Ruan vs. United States making it more difficult for law enforcement agencies to prosecute doctors for prescribing painkillers. The decision raises the bar for criminal convictions, requiring that prosecutors prove that physicians knowingly or intentionally prescribed opioids inappropriately, not just that their practices deviated from government-defined standards. This will help give doctors more legal cover to treat pain as they see fit.
These shifts are early signs that the tides are beginning to turn back toward more access to opioids for patients who need them. But achieving that access will not be easy.
Physician willingness to prescribe opioids is a cultural phenomenon. Doctors have reduced their level of opioid prescribing not just from fear of prosecution but also based on trends in the field. Seminars, institutional guidelines and professional organization statements over the last decade have instilled the idea that prescribing opioids is something to be avoided.
Prescription opioids also remain an enemy in the public consciousness. Although the drugs have been overtaken by black market fentanyl in the overdose crisis, lawsuits against opioid manufacturers continue to command a disproportionate amount of big-swing prosecutorial attention. Of course, companies that deceptively promoted opioids in unsafe ways should be held accountable. But lawsuits against them do nothing to address the current fentanyl crisis, and they may give the false impression that prescription opioids still dominate the overdose problem.
Changing these narratives will take time. Similarly, it is not automatic that the Drug Enforcement Administration, other law enforcement, state governments or billing and insurance companies will change their protocols in line with the new CDC prescription guidance.
Tangible improvements for pain patients probably will happen over years, rather than days or months. They will also require attention to deep disparities in pain care and treatment access. My colleagues and I found in a 2019 study that opioid prescription rates in California varied by 300% based on neighborhood income and racial composition (with predominantly white neighborhoods being most likely to receive opioids and other controlled substances). This reminds us that medical guidelines are not neutral and need an intentional focus on equity to be implemented fairly.
Nonetheless, advocates, physicians and researchers working toward the goal of adequate pain treatment have cause for optimism. The question now is how readily doctors, insurance companies and law enforcement will respect the wisdom of current scientific evidence and legal standards.
Joseph Friedman is a substance use researcher at UCLA who studies the overdose crisis. @JosephRFriedman
This past November, CMS announced that starting January 1, 2023, Medicare will pay physicians in all states and other practitioners with prescription authority such as Nurse Practitioners (NP’s) and Physician Assistants (PA’s) in some states, to perform comprehensive pain management for their patients living with chronic pain. Medicare health insurance covers individuals over the age of 65 and disabled Americans.
CMS has created two specialized billing codes just for chronic pain management (CPM codes G3002 and G3003) that these health care practitioners can use to get paid for their time spent caring for patients and coordinating patient care with other health care practitioners like physical therapists, psychologists and even complementary practitioners such as massage therapists and acupuncturists.
Did CMS include patient input in the ruling?
Yes! CMS released a draft version of this idea in July 2022 and posed many questions asking for patient and other stakeholder input. The U.S. Pain Foundation sent an alert this summer explaining the kinds of input they were seeking. Thank you to those who took action! U.S. Pain Foundation submitted a lengthy comment to the docket answering CMS’s questions from the patient perspective. You can read our comment here. We are pleased that CMS really did incorporate our recommendations into the final rule. In fact, they quoted the organization’s comment 12 times in the final rule.
How will this improve pain care?
How will I know if my doctor is using this code?
Do the new codes allow telehealth visits with my doctor?
What about if I have already been seeing a doctor for pain management and have an on-going treatment plan?
Will any doctor regardless of specialty be able to bill these new CPM (chronic pain management) codes?
Will other public and private insurers cover monthly chronic pain management visits?
NORMAN J CLEMENT RPH., DDS, NORMAN L. CLEMENT PHARM-TECH, MALACHI F. MACKANDAL PHARMD, IN THE SPIRIT OF WALTER R. CLEMENT MS., MBA., BELINDA BROWN-PARKER, IN THE SPIRIT OF JOSEPH SOLVO ESQ., IN THE SPIRIT OF REV. C.T. VIVIAN, JELANI ZIMBABWE CLEMENT, BS., MBA., WILLIE GUINYARD BS., IN THE SPIRIT OF ERLIN CLEMENT SR., JOSEPH WEBSTER MD., MBA, BEVERLY C. PRINCE MD., FACS., LEROY BAYLOR, JAY K. JOSHI MD., MBA, ADRIENNE EDMUNDSON, ESTER HYATT PH.D., WALTER L. SMITH BS., IN THE SPIRIT OF BRAHM FISHER ESQ., MICHELE ALEXANDER MD., CUDJOE WILDING BS, MARTIN NDJOU, BS., RPH., IN THE SPIRIT OF DEBRA LYNN SHEPHERD, BERES E. MUSCHETT, STRATEGIC ADVISORS
LESLY POMPY MD
NOTES FROM TRIAL IN FEDERAL COURT DETROIT MICHIGAN
(notes may not reflect the actual date of testimony, only the date received)
Diane Greer:
“..It’s horrible what they did to this good man!! May the ones who participated in his persecution get the same in return for their evil behavior..”
December 19
Testimony:
Dr. Moulton (The Jamaican Dermatologist) testified that she sent her daughter ( Nonaigne) to me, she described how Nonaigne wanted more pain medications. I refused, Nonaigne went to a different pain doctor, who later abandoned her. Nonaigne subsequently overdosed on Heroin and died in Maryland. Dr. Moulton cried on the witness stand, with a deep impact on the jury.
Dr. Shah testified as to to Interstitial cystitis, being incurable , and causing lifelong pain and suffering.
Former patient Jes Staten testified that his great life came to an abrupt end after a car accident. His hip exploded. Surgery wasn’t an option. I did the platelets rich plasma for his hip.
The surgeons at University of Michigan could not believe how his shattered hips was healed. I prescribed Jes the stimulant Ritalin.
Prosecutor Wayne Pratt ascribed the Ritalin as treatment of side effects of opioids.
Jes described to the Jury that after weeks of chemotherapy for brain cancer ( astrocytoma), he was week and sleeping 19 hours per day. I prescribed the Ritalin so he could stay awake.
Former patient Steve Ellison was a former nuclear technician for the U.S department of energy. Steve was involved in a car accident, became addicted to the pain pills, lost his job and his family.
One day he was suicidal, went on top of the bridge in Monroe to jump. He called his father who came to get him from the suicidal bridge. I put Steve on addiction medicine, turned his life around, and now has a job in construction and family back.
Dennis Helm testified that Dr. Pompy brought platelets rich plasma to Monroe, successfully treated his knee.
After the 9/26/2016 raid he could not find another doctor to do it for him but at 3 times the cost. Insurance does not cover platelets rich plasma and he could not pay for the added costs, per each knee.
Dennis ended up with surgery of his knees and subsequent lengthy painful recovery. Earlier in the trial one former employee who had turned witness for Wayne Pratt had accused Dr. Pompy of trading a truck with Helms for OxyContin.
However, this was a damn lie….”I had never,” Pompy writes, “prescribed Dennis Helm pain medications since he (Helm’s) was under treatment at the Ann Arbor’s Veterans hospital. Dennis is a Vietnam vet disabled by agent Orange in Vietnam.”
Prosecutor Wayne Pratt hid a column on the Medicare payments to Dr Pompy for medical services rendered to Dennis’s wife, Ines Helm. Wayne insinuated that Dr. Pompy billed Helm’s insurance for services not rendered.
My attorneys Chapman and Donnini caught the Wayne Pratt attempt to deceive the Jury. Jurors frowned at the intentional misrepresentation, sleight of hand, by Wayne Pratt as he was attempting to manufacture a health care fraud charge. ( billing for services not rendered)
The Defense Rested Closing Arguments Tuesday December 20, 2022.
HIGHLIGHTS
Dr. Murphy:
My medical expert witness, Dr. Murphy ( no relationship to Judge Murphy, of the case), began to testify. He showed how the undercover from the Blue Cross Blue Shield, fabricated medical records obtained from Dr. Robertson. Marc Moore denied he participated in the fabrication of medical records for Blue Cross Blue Shield of Michigan Mutual Insurance Company, James Stewart, aka James Howell.
Marc Moore conceded that he had no medical training, and no billing and coding knowledge. Marc Moorelacks the education, training, or experience to issue a legal opinion as to the illegal distribution of controlled substances, or insurance fraud.
My attorney played the tape of Marc Moore mocking my education. Marc Moore testified that he was keeping his cell phone on 9/26/16 so that he would see all of the drug addicts texting him to buy drugs.
December 12
Brian Bishop was the DEA agent who was actually present at the raid on 9/26/16. Bishop will not testify. Michelle Cooper of the Diversion Department of the DEA testified that the DEA helped doctors but did not do that for “Dr. Pompy.”
1)They could have helped with record-keeping ideas, but the DEA did not.
2)The DEA performed no investigation prior to the 9/26/16 raid. I was not on their radar.
3)The DEA did not check whether the number of Suboxone patients was correct, above, or below. She agreed that going over the limit of the Suboxone patients was not a criminal offense.
4)After the raid, the DEA reduced my Suboxone patients from 275 back down to 100.
5)Diversion investigator Michelle Cooper had no idea why my Suboxone limit was dropped, after the raid.
6)Chapman found it strange that the drop occurred after the raid.
7) The jury was fascinated by prosecution witness Diana Knight’s testimony: proper billing occurred and nothing was fraudulent. Diana was Dr. Pompy’s medical office biller. She maintained composure during intense, relentless attacks by AUSA Wayne F. Pratt. She won the jury’s heart.
December 8
Good day
Brent Cathey of Monroe City Police, now Police Captain after the 9/26/16 raid, saw what appeared to be medication bottles, with an expired date, at the house. Brent Cathey did not know what was in the bottles. The bottles were not chemically tested.
Tracey Lapalme, a former addiction patient testified that Dr. Pompy made her an addict. She was surprised to find out that Dr. Pompy had her on Suboxone, from the first visit, to treat any medication misuse she may have had. Suboxone can treat pain and substance misuse.
Stephanie Stine testified that her boyfriend, Scott Jones, would beat her up, and take half of her medications. She did not report either the abuse or the taking of her medications by Scott Jones to Dr. Pompy. She testified that she had interstitial cystitis ( an incurable, painful disease of the bladder that causes pelvic and abdominal pain ), and endometriosis since she was 15. She is still on medications.
..the question we now ask have these doctors done wrong???
Amid a weakening macroeconomic environment and ongoing pressure by private and public payers to reduce healthcare costs, a growing number of healthcare companies are faced with credit rating downgrades and potential defaults.
The healthcare industry’s social risk is also rising, exemplified by credit negative legislation such as the No Surprises Act and ongoing litigation around opioids, according to Moody’s Investors Service in a new report.
Among 193 rated North American-based healthcare companies, 34, or nearly 18%, were rated B3 negative or lower as of Nov. 30, up from nine, or about 4%, of rated healthcare companies as of Dec. 31, 2015. About 80% of North American healthcare companies are now speculative grade, as compared to around 73% in 2015 and 71% in 2010, Moody’s reported.
Credit stress is rising in healthcare, which has long been considered a defensive sector for credit investors. The ratings of 24 North American healthcare companies have been downgraded to B3 negative or lower, representing a “material deterioration” in the sector’s credit quality, write Moody’s analysts.
Healthcare companies now represent approximately 16% of the 207 companies on Moody’s Investors Service B3 Negative and Lower List (B3N List) as of Nov. 30.
Updated monthly, the B3N List includes all nonfinancial corporate issuers in the U.S. that meet the firm’s proprietary definition of credit stress—those with a probability of default rating (PDR) of Caa1-PD or lower, or B3-PD with a negative rating outlook or review for downgrade.
“Attracted by healthcare’s historical stability and buoyed by accommodative debt markets, financial sponsors have aggressively consolidated fragmented subsectors,” including physician practices, emergency medicine and anesthesiology, Jean-Yves Coupin, vice president, corporate finance group, Moody’s Investors Service, wrote in the report.
“The resulting roll-ups carry high levels of debt, which will pressure their cash flows and limit their ability to adapt to the changing macroeconomic environment, as well as to increasing social risk, new legislation and litigation,” Coupin said.
The 34 healthcare companies on the B3N List have nearly $65 billion of outstanding debt, an increase of 57% compared to March 2020 at the onset of the pandemic and more than double the nearly $33 billion in debt outstanding in January 2019.
The increase is largely attributable to two recent additions to the healthcare roster that together account for nearly half of its total debt: Bausch Health Companies with about $21.8 billion of outstanding debt and Envision Healthcare Corp. with about $7.9 billion. Excluding Bausch Health, Envision has the largest debt load among healthcare companies Moody’s list, accounting for 18% of total debt outstanding, followed by Team Health Holdings and Radiology Partners, each accounting for nearly 8%. Individuals who are struggling with medical and business debts should consider implementing Customized Debt Relief Strategies.
In September, Moody’s has issued a scathing corporate credit rating downgrade to Envision Healthcare, assigning the physician staffing service and ambulatory surgery center operator its lowest possible junk rating and warning that a bankruptcy or major restructuring is likely on the horizon.
Many healthcare companies rated B3 negative or lower started 2022 with high financial leverage, high levels of floating rate debt and weak operating performance, according to Moody’s. With rising interest rates, these companies now have to contend with higher financing costs amid persistent inflation along with slowing economic growth that will pressure earnings well into 2023.
“Finding lenders willing to refinance will become increasingly difficult in the year ahead as the market retrenches,” analysts wrote.
Thirteen healthcare companies have defaulted since January 2020, with high leverage and weak operating performance as the two main culprits, Moody’s analysts noted. This proves the industry is not immune to the profit and cash flow pressures challenging many industries today.
Operating weakness came from a variety of sources including technological obsolescence, shortages in skilled labor or increases in labor costs, changes in the operating environment or simple mismanagement.
For some defaulters, disruption caused by the COVID-19 pandemic was the last straw.
Looking ahead amid a challenging economic environment in 2023, capital structures of the healthcare companies rated B3 negative or lower will become “unsustainable” as they contend with higher financing costs and find it increasingly difficult to find willing lenders to refinance.
“Companies with unsustainable capital structures will need to cut their cash interest expense by either seeking to convert their debt to payment-in-kind (PIK) obligations, completing debt-to-equity conversions, or through debt extensions. Lenders will likely accept these maneuvers to avoid borrowers filing for bankruptcy, which would result in greater losses,” analysts wrote.
Moody’s analysts noted that private equity activity in the sector contributed to the uptick in companies on the lower end of the ratings scale.
Nearly 90% of the North American healthcare issuers on the B3N List are controlled by private equity, reflecting “aggressive financial policies, high leverage and debt structures predominantly funded with floating-rate loans,” analysts wrote.
As credit conditions worsen and interest expense rises, these companies’ cash flow have increasingly come under pressure, which limits their ability to adapt to changing industry dynamics such as increasing social risk, new legislation and litigation.
Two of the largest healthcare companies on the B3N List are owned by private equity: physician staffing companies Envision Healthcare, which has defaulted on its debt twice since January 2020, and Team Health, which we downgraded to Caa3 in October, Moody’s noted.
Analysts warned that many of the downgraded companies face the same factors that caused 13 healthcare companies to default.
Labor costs, which have risen in most industries, have been particularly credit negative for healthcare companies, which have also been plagued by labor shortages. “Labor issues led to ratings downgrades to B3 negative or below for several healthcare staffing companies, which have struggled to find sufficient labor to provide necessary care at a cost at which they can remain profitable,” analysts noted.
Technological obsolescence is another factor that has led to recent downgrades. For instance, Lifescan Global is seeing its traditional blood glucose monitoring equipment being replaced with newer technology that is much more popular with patients. Another example is Carestream Health, which specializes in traditional medical film for X-rays—a technology that is being rapidly replaced by digital imaging.
Changing industry dynamics, including new legislation or regulations, can cause additional headwinds and drive downgrades, Moody’s said.
